Is it possible for the children below to achieve a state of health?

• A child with a congenital condition – for example, talipes
• A child who has learning disabilities 
• A child who has a long-term condition – for example, type 1 diabetes

Answer: These children, despite having on-going health and life-limiting disabilities, can experience health and wellbeing. They may need additional help, such as splints, physio, medication or adaptations, to help them maximise their health and enable them to take all the opportunities life has.  They may view their health status as a daily (or hourly) event, e.g. ‘today I feel great’  

Watch Bailey Matthews, who despite living with cerebral palsy completed a triathlon race:

www.bbc.co.uk/sport/sports-personality/35129597

www.youtube.com/watch?v=ckFx-pQEmF4

As a children’s nurse we need to work with children and families to enable them to reach their full potential, both as children but also into their adult life.

Watch the video entitled ‘We asked London children – what does being healthy mean to you?’ which shows London children discussing what being healthy means to them:

 www.youtube.com/watch?v=pVzcVfIQ2Ao

Make notes on what you think about their views and if they surprise you or not. Would these views be different in another country or part of the world?

Samira is 7 years old and has suffered repeated urinary tract infections since she was 2. She takes prophylactic antibiotics and has regular scans to monitor renal functioning. Samira lives in privately rented accommodation with her mum and brother aged 3 years. Mum, Jamila, does not work at the moment and suffers with depression and anxiety and relies on child benefit and Jobseekers allowance to financially support the family.

Their house does not provide the best living conditions – the children share a bedroom whilst Jamila sleeps in the lounge. The kitchen is basic; the fridge is old and only 2 rings on the cooker work. Samira hates the cold, damp bathroom and delays using the toilet. As a consequence occasionally she wets herself.

Samira attends school which she enjoys but she has made few friends and one of her peers has called her smelly.

Jamila does her best to look after her children on her own but sometimes she wishes she could just stay in bed. She knows she needs to encourage Samira to empty her bladder regularly but her brother demands so much of her attention that Samira doesn’t get a look in. Jamila feels guilty as she sometimes forgets to give Samira her medicine.

• What do you think Samira’s definition of health would be?

Answer: Samira may have included in her definition not feeling ill, happy, going to school, playing with brother, no more rows.

• List the influences, both positive and negative, on Samira’s health and wellbeing.

Answer:

Negative

• UTI
• Feeling unwell
• Break down of parents’ relationship
• Absence of dad from family house
• Private rented accommodation – in a poor condition
• Would like more friends
• Sad about friends calling her names
• Her brother is always moaning and gets more attention
• Mum looks sad

Positives

• Medicine helps her painful tummy
• Enjoys school
• Loves her mum and her brother
•  Do you think Samira’s definition of health would be the same as Jamila’s?

Answer: Jamilla’s definition is likely to have more emphasis on absence of material resources, e.g. being on benefits. She may also include mental health and wellbeing aspects and the need for adult conversation and support. 

Review the video from the Doc Mike Evan series which explores how all these factors affect brain development – called ‘Saving Brains, A Grand Challenge’:

www.youtube.com/watch?feature=youtu.be&v=vw0TkwjjpZU&app=desktop

www.ncb.org.uk/

How may you:

• Ensure you maintain stimulation for children in hospital?

Answer: Some ideas may include (but you may have others):

1. Making sure children have age appropriate activities that stimulate and/or educate
2. Refer to play specialist when possible
3. Refer to school at hospital

• Encourage parents to engage in stimulating their child?

1. Encourage parents to learn through watching you and the play therapist work with children
2. Give advice re age appropriate toys for the immediate and future development needs
3. Encourage friends who are part of the child’s support network to visit

Review Samira’s story.  What are the positive and negative factors that are influencing Jamila’s ability to parent Samira?

Answer:

Positive which can foster resilience

• Loving relationship with Samira and her brother
• End of negative relationship
• Regular contact with nurse for Samira’s scans

Negatives which affect family relationships and coping mechanisms

• Depression
• Low income
• Reliance on benefits
• Managing Samira’s on-going illness
• Managing her brother’s demands
• Impact of living conditions
• Lack of adult support

Reflect and discuss with mentor or peers

What influences a parent’s decision to immunise their child?

Answer:

• Whether they themselves were immunised or not
• Grandparent’s attitudes towards immunisation
• Information about the benefits of immunisation
• Information regarding the side effects of certain vaccines.

What influences how parents discipline their child?

Answer:

• The way they were disciplined by their parents
• Whether they were physically punished
• Whether they were disciplined using positive behavioural rewards

What influences parents’ attitude towards their teenagers drinking alcohol?

Answer:

• Their own attitude towards alcohol
• Whether alcohol was part of family life when they were growing up
• Their knowledge about sensible drinking.